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Coronary calcium weeds out JUPITER-like patients who will benefit from statins, beats CRP for risk prediction

23 October 2012
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American Heart Association

When it was published and presented two years ago, JUPITER created quite a stir, particularly since the trial showed that patients with normal LDL-cholesterol levels but with other risk factors would be eligible for statin therapy.

Roughly half of patients meeting the criteria for statin therapy based on Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) have a low risk of cardiovascular events when assessed with coronary artery calcium (CAC) imaging scans, according to the results of a new study. Among patients with calcification of the coronary artery, the risk of cardiovascular events was significantly greater than those without calcification, suggesting that CAC assessed by computed tomography (CT) might be used to further stratify at-risk patients for statin therapy.

Lead investigator Dr Michael Blaha (Johns Hopkins Medical Institute, Baltimore, MD) said, "If you fit the JUPITER criteria, which is sort of an older population, and you have no coronary calcium, your event rate is so low that you can't expect to get much from a statin in terms of event reduction in the next five to 10 years. The other patients we saw had calcium, with 25% of patients having the most calcium, and their event rate was 20 times that observed in patients without calcification."

The analysis was presented earlier this week at the American Heart Association (AHA) 2010 Scientific Sessions.

In a second analysis comparing hs-CRP vs CAC for risk prediction, the group found that CRP did not predict events after adjustment for other risk factors among the 2083 MESA patients who met the criteria for JUPITER. CAC, on the other hand, had a strong relationship with clinical events, regardless of CRP status.

"We think that it is time to move past traditional risk factors and serum biomarkers and toward incorporation of measures of subclinical atherosclerosis in risk prediction," said Blaha. "This makes sense because we are directly measuring the disease we propose to treat with statins. Measuring subclinical atherosclerosis can help determine who is more likely to benefit from statins and who is unlikely to benefit. . . . We are not saying that everybody needs a CAC scan. However, it is very helpful in asymptomatic patients in whom the question of statin benefit is uncertain."

Read 1208 times Last modified on Tuesday, 04 December 2012 12:01

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